Deliveries <20 weeks...Need opinions please!

  1. I'll try not to write a book here, but it's kind of a long story.

    Part of my job is perinatal bereavement counseling. On our floor, we see IUFD's, stillborn, and neonatal deaths usually > 20 weeks. Once in awhile, we admit lesser gestations. Our bereavement program is fantastic! We provide great support, take pics, provide momentos, and keep in touch, sending cards, f/u phone calls, etc...

    In Ohio, gestations > 20 weeks have to be buried or cremated, but <20 weeks is optional. So, if the parents decide not to bury or cremate the baby, hospitals will "dispose of" the baby. One of our nurses took it upon herself to start a program where these babies will be cremated and buried at our local burial park (instead of thrown out with medical waste). We have a ceremony every year to remember these babies. The parents are invited, and it is truly a blessing.

    That being said...Those who have early AB's, vag bleeding in ER or abort at home receive absolutely no bereavement services at all. I understand that some women may not see the fetus as a baby, and aren't all that upset, but some have that baby in college after the pregnancy test is positive. This can be gut wrenching and life changing for many of these women.

    In our ER now (I'm not picking on them at all, it's just how they've been trained to care for these people), if a fetal demise is delivered, the baby is placed in a specimen container, the woman is kept until her bleeding has slowed, and adios. The woman then goes home, where her loss is many times never validated. If she works, she'll probably get a day or two off, and then, back to "normal".

    I want to do something!!!! I feel like I need to help these women. What I want to do is provide brief inservices to ER, Surgical, and Dr. office staff, develop a little packet (something the mother can take home), with a poem, a letter from bereavement making ourselves available, and a momento...something they can take home in their otherwise empty arms (a charm or small blanket, something). I also want ER to know that our services are available to them if they need us.

    I just don't know how to go about this, what anyone else does, and how to get started. I know it's a big endeavor, but to me, it's sooooo worth it!

    Thanks so much for any input!
  2. Visit dansmom6 profile page

    About dansmom6

    Joined: Aug '06; Posts: 30; Likes: 7
    OB RN, Bereavement Counselor, OB nursing instructor
    Specialty: 9 year(s) of experience in LTC, Med/Surg, OR, OB, instructor


  3. by   babyktchr
    I too do bereavement and we recently added an ED nurse to our group who deals specifically with the early losses. A few months ago we did an all day sensitivity training day for the ED staff..specifically addressing how to deal with loss in a busy ED. We had a great turnout, but it is certainly not enough. It is hard in such a busy place to connect. What we concentrated on was making memories when there seems to be encouraging memory boxes being made by mom, placing ultrasound photos, other momentos of the pregnancy in a if taken of the loss etc. There is a packet they are given with support group information and there are follow up phone calls.

    If you go to the RTS website, they have idead on memory boxes for early losses, and momento building. They also sell great memory boxes for early losses, baby rings and other stuff. They are at

    Working with family with loss is a special calling to me. It touches my heart on so many levels. I so appreciate your spirit in wanting to do more for you patients. Good luck to you.
  4. by   PRESLA
    ] Your hospital sounds like mine c the care of their pts <20 weeks we have a womens surgery unit that threatened AB's or miscarriages p D&C's if needed go to, but also our OB will send them to L&D for care because they know that it freeks out other depts.

    Keep up the great and caring work hard area to work in.

  5. by   traumaRUs
    Wow - my hat is off to you guys! You do such a wonderful job. I worked in the ER for 10 years and remember placing many "products of conception" in specimen containers. They were then walked over to pathology (versus being sent in the pneumatic tube). I would have welcomed such an inservice.
  6. by   ElvishDNP
    This is kind of on the same subject....but I personally really hate sending babies down to pathology in that stupid container. Our specimen containers are fairly narrow and deep, so you have to curl the baby up and you verge on dropping him/her in there. We do it, of course, with as much care as we can, but we hate it. It feels so dehumanizing.

    Dansmom, I hear you. I think it would be great to give our ED an inservice and make our services available to them. It's so difficult to begin with, and I know ED is always slammed so it makes it really hard to take the time the pt deserves. You have given me a great idea, so thank you very much.
  7. by   dansmom6
    Thanks for all your input!!

    Memory boxes would be optimal, and we do use them on our unit for deliveries >20 weeks, but the cost factor swayed me to the idea of a packet, in a folder, and we'd try to make it pretty...I know that's not as nice as a box, but we pay for the supplies ourselves.

    With around 200 babies yearly <20 wks, it may be difficult to swing the box idea. Any other momento ideas?

    Wow, day-long sensitivity training would be fantastic, but I don't think it'll fly at this time. That is certainly an idea for in the future, though~~~ For now, I want to try to basically put the idea in their heads (staff), because I know a lot of them are uncomfortable with the care, and may be resistant to the idea.

    Thanks again!
  8. by   babyktchr
    We have our memory boxes donated by a local art league. They hand paint all different sized hat boxes very tastefully and place a note inside each one telling where it came from. We used to use the padded boxes from RTS but they are expensive. These are donated and we get quite a few. Perhaps you could get a local group like that to donate. You would be amazed at what people will donate when you tell them what is it for. I put out a lot on stuff for our bereavement memory making and it does add up. Using the community for different things does come in handy. We have a bunch of older women who make clothes and hats, and another group that has had losses making outfits for smaller demises. It is all wonderful. I try to talk to local craft shops and get discounts and donations from them also.

    I think mostly the follow up phone calls for early losses are important. Most times these moms are forgotten...that their loss was less because it wasn't term, which isn't true. Letting them know that they are remembered, as well as their baby.
  9. by   canoehead
    I worked OB when every woman in our ER got bereavement counselling from an OB person. For most of those women it was really overkill, but once seemed very helpful. I suggest the ER staff make the call as to whether someone needs additional help, rather than having a blanket policy that everyone gets it.
  10. by   dansmom6
    Thanks for the ideas, babyktchr!! We also have some women who knit blankets & hats, but neer thought of a donation for boxes...I'm sure someone could help out.

    I agree with you, Canoehead...I definately think it would be overkill for someone from bereavement to insist on being present with every patient. Let's face it...some with early AB's aren't really bothered by it (not that I'm saying that's wrong or's just not a big deal to them). In those situations, I feel it would be adequate to give them the info and other things, and if they wanted to talk to someone later, they could.

    Thanks again, all you're the best!!
  11. by   RainDreamer
    I can't add anything, but just wanted to say thanks for doing such an amazing thing for these women.
  12. by   CT Pixie
    I also can't add anything but I wanted to tell you that your compassion is truly heart warming!
  13. by   OB Night Nurse
    Whatever you decide to do, many elderly people are happy to volunteer in making whatever you want. At our hospital, our volunteers will knit hats for the NICU babies. If your hospital doesn't have a volunteer staff, you could enlist the help of your local senior citizen day group to help make folders, boxes, charms, etc.

    You're doing a really great thing!
  14. by   33-weeker
    At our hospital the ER may save lots of lives, but they don't get it when it comes to OB. Once they brought a women up after she miscarried with the plastic bucket that contained her baby in her lap! How heartless is that?! Is it any wonder that L&D & ER are mortal enemies?

    ER needs some sort of berievement training for maternal losses.

    Up here we make a memento box, take tasteful pictures of the baby dressed in handmade gown, hat & blanket and make a plaster mold of the baby's foot print impressions.